Cardiovascular disorders in children as a long-term outcome of bronchopulmonary dysplasia

Objective. To assess the frequency and characteristics of cardiovascular disorders (CVD) in 2-year-old children with a history of bronchopulmonary dysplasia (BPD).

Materials and methods. A retrospective study was conducted based on the analysis of 137 outpatient records of children discharged from perinatal centers in Yekaterinburg. The study included patients with confirmed BPD. Cardiovascular parameters, physical and psychomotor development, vision, and neurological status were evaluated on the basis of the data recorded in the patients` charts. The children were categorized into CVD risk groups: low (41.7 %), medium (43.9 %), and high (14.2 %). The analysis encompassed echocardiography (EchoCG), electrocardiography (ECG), renal and thymus ultrasound examination results, as well as findings from clinical examination by pediatric cardiologists, ophthalmologists and neurologists. Physical and psychomotor development was assessed using the Griffiths scale and the Denver Development Screening Test II (DDST-II).

Methods of statistical analysis. Statistical analysis was performed using Microsoft Excel 2019 and SPSS for Windows, version 20.0. Qualitative data are presented as absolute numbers and percentages; for their comparison, the χ² test with Yates`s correction and Fisher`s exact test for small sample sizes were applied. The normality of quantitative data distribution was assessed using the Shapiro-Wilk test. For non-normally distributed data, results are presented as median and interquartile range (Me (25 %–75 %)). The Mann – Whitney U test was used to compare quantitative variables between groups. Statistically significant differences were considered with p < 0,05.

 Results. 2-year-old children in the high-cardiovascular risk group demonstrated a higher frequency of deviations in physical and psychomotor developmental, rhythm disturbances, myocardial repolarization abnormalities, and signs of neurological impairments. These changes were less pronounced in the medium- and low-risk groups. All major differences between groups were statistically significant. The frequency of myopia and astigmatism did not differ between the study groups. The high-risk group also showed a greater prevalence of signs of hypertensive-hydrocephalic syndrome and chronic bronchopulmonary diseases. All major differences between the groups were statistically significant.

Conclusions. By the age of 2 years, a high frequency of CVD was identified in children with a history of BPD (66.4 %). The severity of CVD was dependent on the early prognostic risk level: the most severe impairments were observed in the high-risk group, whereas the children in the low- and medium -risk groups had significantly less pronounced changes. The prognostic risk established in the perinatal period influences subsequent outcomes.

Thus, the CVD outcomes in 2-year-old children with a history of BPD confirm the critical importance of early risk prognosis for determining the strategy for their further long-term follow-up and individualized management.